HEART - Fenestration, aortic valve

The heart has been opened to display the aortic cusps; these show fenestration at several points. Classically the fenestrations appear adjacent to the commissures and are asymptomatic, because they are usually above the level of apposition; incompetence will occur if there is associated dilatation of the valve ring or if the fenestration ruptures to the free edge of the valve. Ref. American Journal of Medicine 1958; 24:549.